EXAM 1 Flashcards
Assessment & Concepts of Care for Pts w/ Eye & Vision Problems
1
Q
arcus senilis
Ch. 42
A
an opaque, bluish- white ring within the outer edge of the cornea
Ch. 42
2
Q
cataract
A
A lens opacity that distorts the image projected onto the retina
Ch. 42
3
Q
enucleation
A
surgical removal of the entire eyeball
Ch. 42
4
Q
glaucoma
A
a condition in the eye that occurs with increased pressure and resulting hypoxia of photoreceptors and their synapsing nerve fibers
CH. 42
5
Q
hyperopia
A
farsightedness
CH. 42
6
Q
keratitis
A
inflammation of the cornea
CH. 42
7
Q
keratoconus
A
degeneration of the cornea
CH. 42
8
Q
keratoplasty
A
corneal transplant. The surgical removal of diseased corneal tissue and replacement with tissue from a human donor cornea
Ch. 42
9
Q
myopia
A
nearsightedness
Ch. 42
10
Q
nystagmus
A
an involuntary and rapid twitching of the eyeball
Ch. 42
11
Q
photophobia
A
sensitivity to light
Ch. 42
12
Q
primary angle- closure glaucoma (PACG)
A
a form of glaucoma that can have a sudden onset and is an emergency; it is characterized by a forward displacement of the iris, which presses against the cornea and closed the chamber angle, suddenly preventing outflow of aqueous humor. Also called closed-angle glaucoma, narrow-angle glaucoma, or acute glaucoma
CH. 42
13
Q
primary open- angle glaucoma (POAG)
A
The most common form of primary glaucoma; characterized by reduced outflow of aqueous humor through the chamber angle. Because the fluid cannot leave the eye at the same rate it is produced, intraocular pressure gradually increases
CH 42
14
Q
retinal detachment
A
the separation of the retina from the eplithelium
CH 42
15
Q
retinal hole
A
a break in the retina, often caused by trauma or aging
CH 42
16
Q
retina tear
A
a jagged and irregularly shaped break in the retina, which can result from traction on the retina
CH 42
17
Q
cerumen
A
the wax produced by glands within the external ear canal; helps protect and lubricate the ear canal
CH. 43
18
Q
conductive hearing loss
A
Hearing loss that results from any physical obstruction of sound wave transmission (e.g., a foreign body in the external canal, a retracted or bulging tympanic membrane, or fused bony ossicles).
CH. 43
19
Q
external otitis
A
a painful irritation or infection of the skin of the external ear, with resulting allergic response or inflammation. When it occurs in patients who participate in water sports, external otitis is called swimmer’s ear.
CH. 43
20
Q
frequency
A
the highness or lowness of tones (expressed in hertz). The greater the number of vibrations per second, the higher the frequency (pitch) of the sound; the lower the number of vibrations per second, and the lower the pitch.
CH. 43
21
Q
grommet
A
a polyethylene tube that is surgically placed through the tympanic membrane to allow continuous drainage of middle ear fluids in the patient with otitis media.
CH 43
22
Q
intensity
A
a quality of sound expressed in decibels (dB)
CH. 43
23
Q
labyrinthectomy
A
surgical removal of the labyrinth
CH. 43
24
Q
mastoiditis
A
an acute or chronic infection of the mastoid air cells caused by progressive otitis media
CH. 43
25
Me'nie're disease
tinnitus, one-sided sensorineural hearing loss, and vertigo that is related to overproduction or decreased reabsorption of endolymphatic fluid, causing a distortion of the entire inner canal system
## Footnote
Ch. 43
26
mixed conductive- sensorineural hearing loss
a profound hearing loss that results from acombination of both conductive and sensorineural types of hearing loss
## Footnote
CH. 43
27
myringotomy
the surgical creation of a hole in the eardrum; performed to drain middle ear fluids and relieve pain in the patient with otitis media (middle ear infection)
28
nystagmus
involuntary eye movements
## Footnote
CH. 43
29
ossiculoplasty
replacement of the ossicles within the middle ear
## Footnote
CH. 43
30
otoscope
an instrument used to examine the ear; consists of a light, a handle, a magnifying lens, and a pneumatic bulb for injecting air into the external canal to test eardrum mobility
## Footnote
CH. 43
31
the most trusted profession?
nursing
32
The nursing profession has a strong knowledge base of practice built on what?
reproducible research
33
The nursing profession has high-quality what?
patient care and outcomes
34
What is the spirit of inquiry?
* a persistent sense of curiosity
* will raise questions
* challenge traditional and existing practice
* innovative thinking
* extended possibilities for discovery
35
nursing research
the systemic process for answering questions through the discovery of new information with the ultimate goal of improving patient care
36
the research process consists of....
* ask
* collect
* critically appraise the evidence
* integrate
* evaluate
* communicate
37
PICOT stands for what?
* P= population
* I= interview
* C= comparison
* O= outcome
* T= time
38
Where should data be collected for nursing research purposes?
* current (within 5 yrs unless otherwise stated)
* peer-reviewed
* sourced from the US
39
quantitative
* research data expressed in numbers
* historically, the most highly respected
* today, considered the strongest evidence
* examines cause-effect with a goal of discerning an underlining time sequence
40
qualitative
* research findings expressed in words
* looks for meaning
* holistic
* searches for phenomena relevant to human lives
41
Questions to critically appraise research date and sources are?
* reliability
* validity
* applicability
42
factors that indicate a source is reliable
* authority
* precision
* handling
* timeliness
43
peer-reviewed articles are generally considered what?
the gold standard of reseach sources (although they should still be scrutinized according to the reliability preceding factors)
44
associate degree of nursing
* demonstrates awareness of the value or relevance of research in nursing
* assists in identifying problem areas
* assists in collection of data
45
Bachelor of Science in Nursing
* reads, interprets, and evaluates research
* identifies nursing problems and participates in implementation
* uses nursing practice to gather data
* applies findings of nursing and health-related research to practice
* shares research findings
46
nursing informatics
specialty that combines nursing science and practice with information technology so that nurses can recognize, delineate, control, and communicate statisitics, information, comprehension, and insight in nursing practice
47
# b
biometric technology
use human characteristics (e.g., fingerprints) to authenticate or grant access to data or information
48
telehealth
* can be done from a distant site
* used in hospitals
* serves remote populations
49
robot technology
* enables clinicians to interview and examine patients
* connects to language translators
50
Security and Ethical issues
* information for sale
* question of ownership
* unauthorized access
* accidents
51
Rights for Handling Data
1. TIME
2. PERSON
3. ROUTE
4. INTEGRITY
5. CONFIDENTIALITY
52
autonomic nervous system (ANS)
part of the nervous system that is composed of two parts: the sympathetic nervous system (SNS) and the parasympathetic nervous system
53
Babinski sign
dorsiflexion of the great toe and fanning of the other toes that is abnormal in anyone older than 2 yrs and represents the presence of central nervous system (CNS) disease
54
Bell palsy
a peripheral nervous system disorder in which the patient has paralysis of all facial muscles on the affected side (also called facial paralysis). The patient cannot close his or her eye, wrinkle the forehead, smile, whistle, or grimace. Tearing may stop or become excessive. The face appears masklike and sags.
55
clonus (also called myoclonus)
the sudden, brief, jerking contraction of a muscle or muscle group often seen in seizures
56
decerebration
abnormal movement with rigidity characterized by extension of the arms and legs, pronation of the arms, plantar flexion, and opisthotonos (body spasm in which the body is bowed forward)
57
decortication
abnormal motor movement seen in the patient with lesions that interrupt the corticospinal pathways
58
electroencephalography (EEG)
a diagnostic test that records the electrical activity of the cerebral hemispheres of the brain. The frequency, amplitude, and characteristics of the brain waves are recorded.
59
electromyography
a diagnostic test used to identify nerve and muscle disorders, such as myasthenia gravis, as well as spinal cord disease
60
Glasgow Come Scale (GCS)
a tool used in many acute care settings to establish baseline data in each of these areas: eye opening, motor response, and verbal response. The patient is assigned a numeric score for each of these areas. The lower the score, the lower the patient's neurologic function
61
Guillain- Barre' syndrome (GBS)
a rare acute inflammatory disorder that affects the axons and/ or myelin of the peripheral nervous system resulting in ascending muscle weakness or paralysis
62
level of consciousness (LOC)
the degree of alertness or amount of stimulation needed to engage a patient's attention and can range from alert to comatose
63
magnetoencephalography (MEG)
a noninvasive imaging technique used to measure the magnetic fields produced by electrical activity in the brain via extremely sensitive devices such as superconducting quantum interference devices
64
myasthenia gravis
a rare progressive autoimmune disease characterized by muscle weakness as a result of impaired acetylcholine receptors
65
neurotransmitter
a chemical (e.g., acetylcholine and serotonin) within the nervous system that can either enhance or inhibit the neurologic impulse but not do both
66
PERRLA
pupils are equal in size, round and regular in shape, and react to light and accommodation (a desired normal finding for most individuals)
67
proprioception
awareness of body position
68
single-photon emission computed tomography (SPECT)
a diagnostic imaging study that uses a radiopharmaceutical agent to enable radioisotopes to cross the blood- brain barrier
69
trigeminal neuralgia
a persistently painful and debilitating disorder that involves the trigeminal cranial nerve (CN V) and affects women more often than men
70
CN I
Olfactory
71
CN II
Optic
72
CN III
Oculomotor
73
CN IV
Trochlear
74
CN V
Trigeminal
75
CN VI
Abducens
76
CN VII
Facial
77
CN VIII
Acoustic/ Auditory (Vestibulocochlear)
78
CN IX
Glossopharyngeal
79
CN X
Vagus
80
CN XI
Spinal (Accessory)
81
CN XII
Hypoglossal
82
CN XII Hypoglossal
* movement and protrusion of the tongue
83
CN XI Spinal (Accessory)
* controls stength of neck and shoulder muscles
84
CN X Vagus
* sensory: main component of parasympathetic functions- control of heart, lungs, and digestive tract
* motor: control of the pharynx and larynx (phonation)
85
CN IX Glossopharyngeal
* sensory: taste (posterior 1/3 tongue- sour and bitter), sensation in the pharyngeal soft palate and tonsillar mucosa (gag reflex), and salivation
* motor: swallowing
86
CN VIII Acoustic/ Auditory (Vestibulocochlear)
* hearing and balance
87
CN VII Facial
* sensory: taste (anterior 2/3 tongue- salty and sweet)
* motor: supplies all facial muscles
88
CN VI Abducens
* movement of the lateral rectus muscle (outwards)
* mnemonic: LR6- SO4
89
CN V Trigeminal
* sensory: sensation of cornea [corneal (blink) reflex] and facial skin
* motor: muscles of mastication (chewing)
90
CN IV Trochlear
* movement of the Superior Oblique muscle (down and outward) and rotates top of eye toward the nose
* mnemonic: LR6- SO4
91
CN III Oculomotor
* all EOMs except those supplied by cranial nerves IV and VI
* pupillary constriction (direct and consensual)
* accommodation (near focusing of the eyes)
* eyelid elevation
92
CN II Optic
* vision
93
CN I Olfactory
* smell
94
What section of the brain is CN I located?
cerebrum
95
What section of the brain is CN II located?
cerebrum
96
What section of the brain is CN III located?
midbrain
97
What section of the brain is CN IV located?
midbrain
98
What section of the brain is CN V located?
Pons
99
What section of the brain is CN VI located?
pontomedullary region
100
What section of the brain is CN VII located?
pontomedullary region
101
What section of the brain is CN VIII located?
pontomedullary region
102
What section of the brain is CN IX located?
medulla oblongata
103
What section of the brain is CN X located?
medulla oblongata
104
What section of the brain is CN XI located?
medulla oblongata and spinal cord
105
What section of the brain is CN XII located?
medulla oblongata
106
Mnemonic to remember the 12 cranial nerves
Oh, Oh, Oh, To Touch And Feel Very Good, Velvet AH!
Oh- olfactory (I): allows us to smell
Oh- Optic (II): allows us to see
Oh- Oculomotor (III): allows us to adjust pupils and eye lens. move eyelids. rotate eyeballs
To- Trochlear (IV): allows us to move eyeballs
Touch- Trigeminal (V): allows us to chew, feel sensations in the face and mouth
And- Abducens (VI): allows us to move eyeballs
Feel- Facial (VII): allows us to form facial expressions, produce tears, and sensory of the tongue
Very- Vestibulocochlear (VIII): allows us to hear and maintain balance
Good- Glossopharyngeal (IX): allows us to produce saliva, swallow, and taste
Velvet- Vagus (X): allows us to control the peripheral nervous system (PNS)
A- Accessory (XI): allows us to move the neck and shoulder, swallow
H- Hypoglossal (XII): allows us to formulate speech, move the tongue, swallow
107
Mnemonic to Remember if a cranial nerve is SENSORY, MOTOR, or BOTH
Some Say Marry Money, But My Brother Says Big Brains Matter Most
Some: Sensory (olfactory- I)
Say: Sensory (optic- II)
Marry: Motor (oculomotor- III)
Money: Motor (trochlear- IV)
But: Both (trigeminal- V)
My: Motor (abducens- VI)
Brother- Both (facial- VII)
Says: Sensory (vestibulocochlear- VIII)
Big- Both (glossopharyngeal- IX)
Brains: Both (vagus- X)
Matter: Motor (spinal accessory- XI)
Most: Motor (hypoglossal- XII)
108
Mnemonic to remember the order of each cranial nerve
On Old Olympus Towering Top A Fin and German Viewed Some Homes
On: Olfactory (I)
Old: Optic (II)
Olympus: Oculomotor (III)
Towering: Trochlear (IV)
Top: Trigeminal (V)
A: Abducens (VI)
Fin: Facial (VII)
And: Accoustic (Vestibulocochlear) (VIII)
German: Glossopharyngeal (IX)
Viewed: Vagus (X)
Some: Spinal (Accessory) (XI)
Homes: Hypoglossal (XII)
109
afferent
* detects sensory stimuli and transmits the impulse TOWARDS the CNS
110
efferent
* transmits motor impulses AWAY from the CNS
111
112
somatic
* controls voluntary
* connects CNS with muscles and skin
113
autonomic
* regulates involuntary body functions (HR, RR)
114
central nervous system
main control center composed of brain and spinal cord
115
peripheral nervous system
cranial (12 pair) and spinal nerves (31 pair)
116
sympathetic nervous system
* stimulates
* "fight or flight"
-you're in a dark alley....-
117
parasympathetic nervous system
* calms
* rest and digest
118
peripheral nervous system (PNS)
composed of spinal nerves, cranial nerves and autonomic nervous system
119
afferent neurons (aka: sensory neurons)
are specialized to send impulses **towards the CNS**, away from the PNS
120
efferent neurons (aka: motor nerve cells)
carry signals **away from the CNS** to the cells in the PNS
121
interneurons (association neurons)
connect one neuron to another by receiving sensory information and transmitting motor activity impulses
122
neuron do what?
transmits impulses
123
what does the brain do?
* processing information (integrating information)
* controlling various bodily functions
* generating thoughts and emotions
* divided into different regions- cerebellum, cerebral cortex, diencephalon, and brainstem
124
spinal cord does what?
* long, cylindrical structure
* extends from brainstem down the vertebral column
* pathway for communication between brain and body
* reflex activity
125
cerebrum
* the largest part of the brain responsible for a wide range of higher cognitive functions
* divided into 2 hemispheres that controls movement on the contralateral (opposite) side
126
cerebellum
* responsible for coordinating voluntary muscle movements, balance, and posture
* control of body is *ipsilateral (same) side of body
*situated on the same side
127
brainstem consists of:
* midbrain
* pins
* medulla
128
cerebral cortex
* outermost layer of the brain
* sulci (grooves) and gyri (folds)
* gray matter (lacks myelin)
* covers white matter (myelin)
* involved with higher functions of the brain (thinking, planning)
* processes information from PNS
* divided into 4 lobes- frontal, parietal, temporal, occipital
* limbic region includes hippocampus, amygdala, thalamus, and hypothalamus
129
The cerebral cortex is so complex that it is further divided into how many lobes and what are those lobes?
4 lobes
* frontal lobe
* parietal lobe
* temporal lobe
* occipital lobe
130
the cerebral cortex is part of what?
the cerebrum
131
frontal lobe
responsible for movement and all executive function
132
temporal lobe
* responsible for hearing, smell, memory, and visual recognition
* complicated memory patterns
* wernicke area for language comprehension
* primary motor area
* broca- speech/ on dominant side
* voluntary eye movement
* acess to past information or experience
* affective response to a situation
* cognition: judgement, ability to develop long-term goals, reasoning, concentration, abstraction
133
parietal lobe
* responsible for somatosensation (sensory perception from somatic system r/t touch, temp, pain, proprioception)
* sensory perception- texture, size, shape, and spatial relationships
* three-dimensional (spatial) perception
* needed for singing, playing musical instruments, and processing nonverbal visual experiences
* perception of body parts and body position awareness
* taste impulses for interpretation
134
occipital lobe
* primary visual center
135
limbic system
* hippocampus
* amygdala
* thalamus
* hypothalamus
* pituitary gland
136
hippocampus
plays important role in formation of new memories
137
amygdala
involved in processing emtions, particularly fear and pleasure; also influences emotional responses and social behavior
138
thalamus
a central relay station for sensory information, directing it to the appropriate area of the cerebral cortex; plays a role in regulating consciousness and alertness
139
hypothalamus
plays major role in the autonomic system; regulates basic physiological processes (hungar, thirst, and body temperature); controls release of hormones from pituitary gland
140
pituitary gland
located at base of brain, just below the hypothalamus; "master gland"; produces and releases hormones that control other endocrine glands throughout the body
141
diencephalon
* lies below the cerebrum
* includes the thalamus, hypothalamus, and epithalamus
* epithalamus- primarily composed of the pineal gland
* pineal gland- small endocrine gland that secretes the hormone melatonin responsible for regulating sleep-wake cycle (circadian rhythm)
142
brainstem
* posterior part of the brain continuous w/ spinal cord
* 10/ 12 cranial nerves (III- XII)
* Composed of the medulla, pons, and midbrain
143
Medulla
* life-sustaining autonomic body functions (BP, breathing)
* cardiac-slowing center
* respiratory center
144
Pons
* relay station, auditory and vestibular pathways
* CN VII
145
midbrain
* sensory and motor functions
146
tectum
vision and hearing
147
tegmentum
eye movement, pain perception, motor functions
148
meninges
membranes that form protective covering of CNS (brain and spinal cord)
* three layers: pia mater, arachnoid mater, dura mater
149
pia mater
delicate, highly vascular inner layer, provides nourishment by direct contact with brain and spinal cord
150
arachnoid mater
spider-web like middle layer that forms subarachnoid space, contains cushioning CSF
151
dura mater
tough, outer layer that lines inside of the skull and vertebral canal, helps to protect from physical injury
152
cerebral ventricular system consists of how many ventricles
four
153
* store and produced in the cerebral ventricles
* clear, colorless body fluid continuously produced by the choroid plexus
* circulates, surrounds, and cushions brain and spinal cord
cerebrospinal fluid (CSF)
154
encloses and protects the brain
bony cranium (skull)
155
an increase in intracranial pressure will be compensated how?
in a decrease of cerebral spinal fluid
156
causes of increased ICP
* tumors or lesions
* fluid accumulation
* increased blood volume (vasodilation/ bleeding)
* edema of cerebral tissues
157
compensatory mechanisms (ICP)
capacity for spatial compensation is limited
158
the skull is vulnerable to what?
possible accumulating pressure
159
circulation originates in the brain from where?
the carotid and vertebral arteries
160
the 2 posterior vertebral arteries become what? then divides into what?
the basilar artery; 2 posterior cerebral arteries
161
the vertebrobasilar system is responsible for:
20-30% of intracranial blood flow
162
* the 2 arterial systems that supply the brain?
* which is anterior, which is posterior?
* the unite to form the __?
* vertebrobasilar system and the internal carotid
* vertebrobasilar system- posterior (brainstem and cerebellum) ; internal carotid system- anterior (cerebrum and its structures)
* circle of willis
163
3 main pair of cerebral arteries supply blood to the anterior and posterior brain.. what are they?
anterior, middle, posterior
164
brain requires??
continuous supply of blood (oxygen, glucose)
165
what supplies blood to the central portions of the brain and the brainstem?
small artery branches (penetrating arteries)
166
subcortical structures deep within white matter
* limbic systems
* basal ganglia
167
optimal cerebral blood flow is maintained with what percentage of cardiac output?
20% for optimal functioning
168
Peripheral Nervous System is composed of:
* spinal nerves
* cranial nerves
* autonomic nervous system
169
PNS: Spinal nerves existing from the spinal cord
31 pairs
* 8 cervical
* 12 thoracic
* 5 lumbar
* 5 sacral
* 1 coccygeal
170
each cranial nerves has what?
a posterior branch and an anterior branch
171
PNS: posterior branch carries what information?
sensory information ** to** the cord (afferent pathway)
172
PNS: anterior branch carries what?
motor impulses to the body (efferent pathway)
173
what is each spinal nerve responsible for?
muscle and sensory innervation at a given area of the body (dermatomes)
174
175
hyperactive reflex
possible damage to brain or upper spinal cord
176
hypoactive reflexes
possible damge to lower spinal cord
177
generally result in loss on the contralateral (opposite) side of the body
CNS problems (in the brainstem, thalamus, cortex)
178
results in sensory deficit on ipsilateral (same) side of the body
cerebeller lesions
179
pinpoint pupils
opiate poisoning
180
dialated and fixed pupils
brain herniation
181
assessment of cerebeller function
fine coordination of muscle activity
* heel-to-shin test
* finger-to-nose test
* rapid alternating action test
gait and equilibrium
* stand on one foot
* tandem walking (heel-to-toe)
* Romberg test (prevent falling)
182
position for a lumbar puncture
flexed position to open up spinal colomn; L4-L5 to gain entry to the subarachnoid space
183
CN VIII vestibulocochlear nerve is responsible for what?
hearing
184
overgrowth of soft bony tissue around the base of the stapes preventing it from being able to vibrate freely; can be hereditary or from previous middle ear surgery
otosclerosis
185
ototoxic drugs
* NSAIDs
* certain ATBs (aminoglycosdies- gentamycin, vancomycin)
* diuretics (Lasix is a big one)
* quinine-based meds (used to treat malaria)
* certain cancer drugs
186
increases risk for presbycusis (age-related hearing loss)
deficiencies of Vit B12 and folic acid
187
a genetic problem that can lead to hearing loss as adults
down syndrome
188
hearing acuity testing
* HIGH frequency consonants (S, Sh, F, Th, Ch)
* Whispered Voice Test
* Tuning fork test
189
When would you not use an otoscope to examine the ears of a patient?
when the patent is unable to hold his/her head still during the exam or who is confused
190
when is the whispered voice test used?
to detect high-tone hearing loss (whispering is a high-frequency sound)
191
measures hearing by air conduction (AC) or bone conduction (BC) in which the sound vibrates through the cranial bones to the inner ear
tuning fork (test)
192
formal findings: Weber Test (picture a W on the top of the head like a bow)
should be heard equally in both ears and not lateralize
193
normal findings: Rinne Test
air conduction (AC) > Bone (mastoid) conduction (BC)
194
use of a portable handheld device to generate tones of varying intensities; looks like tympanic thermometer, obtains a digital reading
audioscopy
195
is performed by an Audiologist & is the most reliable method of measuring hearing
audiometry
196
the highness or lowness of tones (expressed in hertz); the greater the number of vibrations per sec, the higher the pitch of the sound; the fewer the vibrations per sec, the lower the pitch
frequency
197
is expressed in decibels (dB); sometimes thought of as the amplitude of the soundwave
intensity (of sound)
198
the lowest level of intensity at which pure tones and speech are heard by a patient about 50% of the time
threshold
199
the lowest intensity at which a healthy ear can detect sound about 50% of the time
0 dB
200
conversational speech
60 dB
201
soft whisper
20 dB
202
so intense (loud) that it can be painful for most people with normal hearing
110 dB
203
with a hearing loss of 45 to 50 dB, what may be needed?
hearing aid
204
someone with a hearing loss of 90 dB may not be able to do what?
be able to hear speeech even with a hearing aid
205
ear and hearing changes associated with aging:
* elongated pinna
* hair changes
* cerumen is drier, becomes easily impacted
* tympanic membrane loses elasticity
* hearing acuity decreases (in some, not all)
-ability to hear high-freq sounds is lost first
- problem hearing F, S, Sh, Pa sounds
206
obstruction of sound wave transmission
conductive hearing loss
207
conductive hearing loss
**difficulty in the external ear or the middle ear**
* obstruction of external or middle ear
* changes in eardrum
* otosclerosis
* may benefit from hearing aid
208
sensorineural hearing loss
**difficulty in the inner ear or the accoustic nerve**
* is often permanent
* damage to inner ear or auditory nerve (CN VIII)
* prolonged exposure to loud noise
* ototoxic drugs
* presbycusis (occurs w/ aging)
* may need cochlear implant
209
mixed conductive- sensorineural
a combination of the two
210
sensorineural hearing loss that occurs with aging
presbycusis
211
* caused by degeneration of cochlear nerve cells
* loss of elasticity of the basilar membrane
* decreased blood supply to the inner ear
* tinnitus is common with occational dizziness
* deficiencies of Vit B12 and folic acid increase the risk
presbycusis
212
Weber Test
Normal Finding: Sound should be heard equally in **both ears and not lateralize**
Conductive loss: Sound lateralizes to the **AFFECTED ear**
Sensorineural Loss: Sound lateralizes to the **UNAFFECTED ear**
213
Rinne Test
* Normal Finding: Air conduction (AC) > bone conduction (BC)
* Conductive Loss: ABNORMAL in affected ear (AC < BC)
* Sensorineural Loss: NORMAL in affected ear (AC > BC)
214
postop education (ear surgery)
* straining and forceful coughing increases middle ear pressure and mist be avoided
* bending at the waist should also be avoided
* blow nose gently, when blowing do not block either nostril and keep mouth open
* avoid people with upper respiratory infections
* get adequate rest
* eat a balanced diet
* drink adequate amouts of fluid to maintain optimal health
* avoid getting head wet until advised to do so
* place a cotton ball with petroleum jelly in ear when showering
* move the head slowly preventing vertigo
* change dressing as directed
215
surgical opening of the eardrum
myringotomy
216
placement of ear tubes into your eardrum
tympanostomy
217
inflammation of the mastoid air cells caused by progressive otitis media
mastoiditis
218
s/s of mastoiditis
* ear pain not releived by myringotomy
* swelling behind the ear, cellulitis develops
* can lead to brain abscess, meningitis, and death
219
painful inflammation of the external canal/ear, RAPID onset
* aka: swimmer's ear
otitis externa
220
s/s of otitis externa
* affected skin is red, swollen, and tender
* temp conductive hearing loss
* treat with topical antibiotics, analgesics, steroids
* avoid getting water in ear
221
most common cause of an impacted ear canal
cerumen (earwax)
222
medication that helps presbycusis- associated tinnitus; antiparkinson drug; dopamine agonist that works on the nervous system
Pramipexole
223
Classic trio- vertigo, tinnitus and unilateral sensoreineural hearing loss
Meniere's Disease (Endolymphatic hydrops)
224
buildup of endolymphatic fluid in the labyrinth essential to hearing (cochlea) and balance (vestibular system)
**FALL RISK**
Meniere's Disease
225
pharm tx for Meneire's Disease
* diuretics (HCTZ)
* Vestibular suppressants (lorazepam, diphenhydramine, meclizine)
* antiemetics (prochlorperazine)
226
non-pharm tx for Meniere's Disease
* diet (LOW salt intake, caffiene, MSG, alcohol and nicotine) and lifestyle adjustments (stress and allergens)
* prevent vertigo
* fall precautions
* no driving with "sudden drop attacks"
* vestibular rehab therapy
227
surgical managment of Meniere's Disease
Labyrinthectomy
228
benign tumor of the vestibulocochlear nerve (CN VIII)
acoustic neuroma
229
acoustic neuroma
-s/s
-tx
* tinnitus prg to sensorineural hearing loss
* constant mild-to-moderate vertig
* damages other structures as it slowly grows
* diagnosed with an MRI
* observation, radiation, or craniotomy
230
crossed eyes
strabismus
231
type of strabismus
* esotropia- inward
* exotropia- outward
* hypertropia- upward
* hypotropia- downward
232
double vision
diplopia
233
(r/t the eyes) pain is always...
abnormal
234
slit lamp/ tonometry
235
eye muscles involved in extraocular function
* superior rectus: move the eye upward and inward
* inferior rectus: moves the eye downward and inward
* medial rectus: moves the eye inward, towards the nose
* lateral rectus: moves the eye outward, away from the nose
* superior oblique: rotates the eye downward and outward
* inferior oblique: rotates the eye upward and outward
236
eye function: refraction
bending of light rays
237
eye function: pupillary change
* miosis: constriction
* mydriasis: dilation
238
eye function: accommodation
maintaining a clear visual image when the gaze is shifted from a distant to a near object
239
eye function: convergence
ability to turn both eyes inward toward at the same time to look at a close object
240
refractive errors: emmetropia
perfect refraction
241
refractive errors: hyperopia
farsightedness
241
refractive errors: myopia
nearsightedness
242
refractive errors: presbyopia
farsightedness caused by loss of elasticity (caused by age... 40yrs)
243
refractive errors: astigmatism
unevenly curved surfaces
244
legal blindness
* 20/200 or less w/ corrective lenses in the better eye
* _<20 degree visual field in the better eye
245
conjunctivitis
pink-eye
246
conjunctivitis: bacterial
contagious- purulent drainage, in one or both eyes
247
conjuntivitis: viral
highly contagious- watery discharge, in one or both eyes
248
conjunctivitis: allergic
NOT contagious- stringy discharge in BOTH eyes with excess tearing
249
subconjunctival hemorrhage
* bleeding underneath the conjunctiva
* no pain or visual impairment
* resolves w/o tx
can be caused by:
* trauma
* high BP
* heavy lifting/ straining (BM)
250
* yellowish- raised growth on the conjunctiva
* asymptomatic
* caused by UV light damage
* lubricating eye drops
* rarely, surgical removal
pinguecula
251
* yellowish wedge-shaped growth on the conjunctiva that extends to the cornea
* asymptomatic
* caused by UV light damage
* lubricating eye drops
* can grow, caused blindness
* may need surgical removal
pterygium
252
eyelid abnormalities: exophthalmos
protruding eyes, lid lag
253
eyelid abnormalities: ptosis
drooping upper lid
254
eyelid abnormalities: ectropion
lower lid loose and rolling out
255
eyelid abnormalities: entropion
lower lid contracts and rolls in
256
* painful, red, swollen pustule
* edge of eyelid (upper or lower)
* blockage of oil glands or infected eyelash follicle
* staph
* abrupt onset
* warm compresses
* topical antibiotic ointment/ drops
* educate need for f/u w/ Ophthalmologist if not resolving
Hordeolum (Stye)
257
* painless, hard, beady nodule
* usually, upper eyelid
* chronic, inflammation of Meibomian gland
* gradual onset
* warm compresses
* may need surgical removal
chalazion
258
* inflam of (both) eyelids due to clogged oil glands near the base of the lashes causing irritation and redness
* red, itchy, swollen eyelids that may look greasy or crusted; dry eyes: burning or FB sensation
* often occurs with other skin conditions or allergies
* TX- warm compresses, eyelid scrubs with diluted baby shampoo, artificial tears, eyelid massage, treat underlying condition
* antibiotic or steroid eyedrops may be used
* tends to be recurrent
blephritis
259
* opacity of the lens, distorts images
* gradual, commonly senile (age-related); can also be congenital, traumatic, secondary
* early signs- blurred vision and decreased color perception
* late signs- diplopia, reduced visual acuity (gradual), absence of red reflex, presence of bluish-with pupil
* no pain or eye redness
* blindness, if uncorrected
cataracts
260
preop care: cataract surg
* measures to decrease ICP
* administer eye drops preop, as prescribed:
-Mydriatics (dilate the pupil; commonly phenylephrine 2.5%)
-Cyclopegics (paralyze the ciliary body muscles; commonly cyclopentolate 1%)
261
normal IOP
10-20 mm HG
262
* clear, watery fluid continuously produced in the cilliary bodies
* flows from posterior chamber through pupil to the anterior chamber then drains through the canal of Schlemm into bloodstream
* provides nutrition to the eye and maintains IOP
aqueous humor
263
* painless, gradual loss of peripheral vision, results in "tunnel vision"
* decreased intraocular pressure damages the optic nerve (CN II) {tonometry}
* etiology and genetic risk
* chronic, progressive eye disease with no cure
* **most common cause of blindness in the US, second most worldwide**
* Refer for comprehensive dilated eye exam
* over 40, African-Am, Caribbean, Hispanic/ Latin Am (over 40), over 60, fam hx, high BP, high eye pressure, corneal thickness, abnormal optic nerve
Primary Open-Angle Glaucoma (POAG)
264
* iris adheres to either cornea or lens
-pupillary block
-angle closure
* etiology and genetic risk
* acute or chronic
* **acute is an emergency**
* painful, red eye, with blurred vision, halos around lights, headache, N/V
* peripheral indectomy
Primary Angle-Closure Glaucoma (PACG)
265
non-surg managment of Glaucoma
* adrenergic agonist (-nidine): mydriatic: decreases AH production and increases outflow
266
* converts light that enters eye into images
* CN II
retina
267
Rods
* photoreceptor
* low light
* monochromatic
* peripheral vision
268
cones
* photoreceptor
* bright light
* color
* central vision
269
* 2 types of macular degeneration
1. dry (atrophic)
2. wet (exudative)
270
* more common, less severe, age-related macular degeneration
* slow onset
dry (atrophic)
271
* less common, more severe, any age macular degeneration
* rapid onset
wet (exudative)
272
**emergency** vitreous humor sticks to the retina and tears it away from blood supply
retinal detachment
273
* sudden, painless onset
* **bright flashes of light**
*** floaters or dark spots (signs of bleeding)**
* sense of a curtain being drawn over the eyes
* if untreated, partial detachment becomes permanent
* immediate bedrest, patch both eyes, prepare for surgery (laser photocoagulation, cryopexy, scleral buckling)
retinal detachment
274
scrape or scratch of the cornea
corneal abrasion
275
deeper injury than a corneal abraision, emergency
corneal ulceration
276
* inflam of the cornea
* noninfectious or infectious
* bacterial, viral, fungal, parasitic
dx- corneal staining w/ fluorescent strip
tx- topical antibiotic eyedrop/ ointment, steriods may be used with antibiotic tx to reduce inflammation to the eye
Keratitis
277
Kurt Lewin's Model of Change
* unfreezing
* movement
* refreezing
278
barriers to clear communication
1. language
2. retaliation
3. desire for power
4. low self esteem
5. fear and anxiety
6. stress
279
